Even though the relationship of health with almost everything under the Sun, ought to be the most obvious relationship, yet this realization is seldom reflected in understanding and practice even among those who are in the business of managing health and health care. Even the most wise reflections on the attention ‘Health and Health Care’ has received in the Central budget for the year 2022-23 are found to be short on this assessment.
The most important context for this year’s health budget is the social and economic hardship faced by the people due to the consequences of the economic slowdown existing prior to the pandemic and the enormous hardships resulting from the pandemic. Peoples’ health and well-being has been forged by conditions in which top 20 percent of the population has increased its wealth at rates even higher than the pre-pandemic period, while close to 60 percent of the lower segment of the population has lost more than 50 percent of their wealth. While vast sections of small and medium enterprises and other enterprises constituting the unorganized sector of the economy have simply been wiped out, the big organized sector has further consolidated its stranglehold over huge government had outs, as reflected in the growth of their wealth. They have however contributed little in terms of employment generation and meeting the basic needs of a large section of the population.
The grave situation of unemployment, hunger, poverty and ill-health, all of which have witnessed massive rise in past few years, mandated a much stronger commitment for a robust social security sector funded by the government.
The public expenditure on social services (including health) in India hovered between 6.2 percent of the GDP in 2014-15 to 6.7 percent in 2019-20, and increased barely to 8.6 percent of GDP in the outlay for the year 2021-22. In comparison, the average social sector spending for the OECD countries (almost entirely publicly funded) before pandemic was about 21 percent of the GDP. Portends in this regard remain worrisome by governments’ own statistics.
For example, as against the budget estimate of Rs 2,53,974.3 crores for the Ministry of Food and Public Distribution in 2020-21 the actual expenditure was 5,55,431.7 crores. Yet for the year 2022-23 the allocation has been kept at just 2,15,959.58 crores. This despite the fact that not only has India slipped in ranking in the World Hunger Index, but also the stern nutrition indices in the NFHS 5 data. There couldn’t be a more forthright declaration to the effect that free and double ration for the poor with Prime Minister’s photograph plastered over is only till the assembly elections in UP are over. The cost of same would be realised from the people after the elections.
Another statistic which makes the government appear complicit is the allocation earmarked for Ministry of Rural Development. The budget document shows that as against actual expenditure of 1,96,416.71 crores against budged estimate of 1,31,519.08 crores in 2020-21, the allocation for 2022-23 at 1.35.944.29 crores has again been kept far below what is required. As it is the rural areas that are the entrenched fortresses of poverty, hunger and ill-health, government’s insensitivity towards rural development cannot but be with its consequences for peoples’ health and wellbeing.
The crucial importance of clean drinking water and sanitation for peoples’ health can hardly be overestimated. The fact remains that only 27 percent of the total allocation of 60,030.45 crores in the year 2020-21 actually got spent. This leaves a huge question mark over the fate of an allocation of 67,221.12 crores in 2022-23 as there remains little exposition of the reasons for low performance.
There also need be concerns for peoples’ health with regard to allocation and expenditure incurred by the Department of Women and Child Development. This department runs the ICDS (Integrated Child Development Scheme) scheme that has important bearing on Maternal and Child health outcomes. The department performed under par by spending only 78 percent of its allocated funds (Rs 19,231.06 crores out of 24,435 crores). This year there has been a token increase of just 3 percent in budget allocation for the department.
The above factors have dangerous portends for health, problems of hunger and malnutrition, maternal and child health, increase in incidence and prevalence of communicable diseases which continue to be major killers in our country. Undernutrition does not augur well even for communicable diseases like diabetes and others. Even in routine times India has hardly had any tradition of morbidity surveys to inform policy with regard to these health problems, and in corona times data on these problems has almost been given a go by. Even the data on corona has raised more eyebrows than straighten any.
The allocation of Rs 83,000 crores for health in this year’s budget hardly sounds impressive if we account for the real need and inflationary pressures. To reflect the real commitment of this government to health it need be noted that as against revised estimate of Rs 50,591.14 crores for ‘Centrally Sponsored Schemes’ (which includes the flagship ‘National Health Mission’ Program) in 2020-21, only 39,569.16 crores actually got spent i.e. in the peak pandemic year. Neither do the Finance Minister’s pronouncements afford us an understanding of why only Rs 3,199 crores out of a total allocation of Rs 6,412 crores were spent under the Ayushman Bharat scheme even as people were forced to spend through their nose for covid treatment.
The government has taken due care to not make any commitment for filling the massive backlog of vacancies for doctors and various other health staff which continues to cripple the public health system in the country. Nonetheless, the government has persisted with its penchant for digitization of services, beneficiaries, and perhaps the entire society. The problem however remains that people exist in flesh and blood and experience problems in real terms which digital illusions can hardly cure. The potential of digital technologies can only be realized in the presence of real infrastructure in terms of buildings, human and material resources the vulnerability of which has been exposed beyond denial during the pandemic. In this context the declaration of establishing 23 telehealth centres of excellence for mental health appears as yet another smoke screen cover the lack of government’s competence.
Forcing the governments to change their attitudes and policies albeit falls in the realm of people. PMSF sincerely seeks to draw the attention of one and all in this regard.
Dr Harjit Singh Bhatti, National President Dr Siddharth Tara, General Secretary
PROGRESSIVE MEDICOS & SCIENTISTS’ FORUM